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Vol 17, No 1 (2023)
Research paper
Published online: 2022-11-08
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Single nucleotide polymorphisms as predictors of treatment efficacy and adverse effects of morphine in palliative medicine: a literature review

Aleksander Turczynowicz1, Karolina Niedźwiecka2, Dominik Panasiuk1, Weronika Pużyńska3, Kacper Luchowski3, Julia Kondracka4, Piotr Jakubów12
DOI: 10.5603/PMPI.a2022.0027
·
Palliat Med Pract 2023;17(1):29-38.
Affiliations
  1. Department of Anaesthesiology and Intensive Care for Children and Adolescents with Postoperative Care and Pain Management Unit, Medical University of Białystok, Białystok, Poland
  2. Clinical Department of Cardiac Surgery, Medical University of Białystok, Białystok, Poland
  3. Medical University of Białystok, Białystok, Poland
  4. Medical University of Gdańsk, Gdańsk, Poland

open access

Vol 17, No 1 (2023)
Review paper
Published online: 2022-11-08

Abstract

Introduction: Pain has a significant negative impact on the quality of life of cancer patients and implies numerous clinical consequences. Moderate to severe pain is common in patients receiving palliative care. A major issue is the individual variability resulting in different degrees of response to the analgesic effects of opioids, including morphine, and to the occurrence of their adverse effects. According to one of the theories of pharmacogenomics, single nucleotide polymorphisms (SNPs) are associated with opioid metabolism.

Material and methods: A literature review of the PubMed database identified 18 scientific articles concerning SNPs that affect the analgesic effects and adverse effects of morphine or other opioids, per morphine equivalent, from which additional 22 scientific articles were retrieved.

Results: The review identified SNPs in the genes OPRM1 A118G, COMT rs4680, ABCB1 C3435T, IL-6, IL-8, TNF-α, TAOK3, HTR3B, UGT1A1/UGT1A8 and OPRM1 Arg181Cys, which were found to affect both the occurrence of potential adverse effects and the different demand in palliative care patients for a dose of morphine that will effectively relieve pain. SNPs were found to significantly affect morphine metabolism; the determination of this effect is individual-based. Most studies were conducted in small groups of individuals from ethnically diverse populations, which, if mutations are present, may significantly affect the efficacy of opioid-related SNP assays and the response of patients to the analgesic treatment administered.

Conclusions: Findings raise the prospect of the use of SNPs in clinical practice as part of personalized medicine in the future.

Abstract

Introduction: Pain has a significant negative impact on the quality of life of cancer patients and implies numerous clinical consequences. Moderate to severe pain is common in patients receiving palliative care. A major issue is the individual variability resulting in different degrees of response to the analgesic effects of opioids, including morphine, and to the occurrence of their adverse effects. According to one of the theories of pharmacogenomics, single nucleotide polymorphisms (SNPs) are associated with opioid metabolism.

Material and methods: A literature review of the PubMed database identified 18 scientific articles concerning SNPs that affect the analgesic effects and adverse effects of morphine or other opioids, per morphine equivalent, from which additional 22 scientific articles were retrieved.

Results: The review identified SNPs in the genes OPRM1 A118G, COMT rs4680, ABCB1 C3435T, IL-6, IL-8, TNF-α, TAOK3, HTR3B, UGT1A1/UGT1A8 and OPRM1 Arg181Cys, which were found to affect both the occurrence of potential adverse effects and the different demand in palliative care patients for a dose of morphine that will effectively relieve pain. SNPs were found to significantly affect morphine metabolism; the determination of this effect is individual-based. Most studies were conducted in small groups of individuals from ethnically diverse populations, which, if mutations are present, may significantly affect the efficacy of opioid-related SNP assays and the response of patients to the analgesic treatment administered.

Conclusions: Findings raise the prospect of the use of SNPs in clinical practice as part of personalized medicine in the future.

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Keywords

pain, morphine, cancer, palliative care, gene polymorphisms

About this article
Title

Single nucleotide polymorphisms as predictors of treatment efficacy and adverse effects of morphine in palliative medicine: a literature review

Journal

Palliative Medicine in Practice

Issue

Vol 17, No 1 (2023)

Article type

Research paper

Pages

29-38

Published online

2022-11-08

Page views

2623

Article views/downloads

312

DOI

10.5603/PMPI.a2022.0027

Bibliographic record

Palliat Med Pract 2023;17(1):29-38.

Keywords

pain
morphine
cancer
palliative care
gene polymorphisms

Authors

Aleksander Turczynowicz
Karolina Niedźwiecka
Dominik Panasiuk
Weronika Pużyńska
Kacper Luchowski
Julia Kondracka
Piotr Jakubów

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